Healthcare Provider Details

I. General information

NPI: 1801136064
Provider Name (Legal Business Name): MARY BRADY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 03/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY GUIDANCE CENTER OF MILFORD 16 ELM ST
MILFORD NH
03055
US

IV. Provider business mailing address

FAMILY GUIDANCE CENTER OF MILFORD 16 ELM ST
MILFORD NH
03055
US

V. Phone/Fax

Practice location:
  • Phone: 603-672-5005
  • Fax: 603-628-7757
Mailing address:
  • Phone: 603-672-5005
  • Fax: 603-628-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1267
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: